North Carolina-based Upstream is betting on a new kind of health care system the U.S. has only recently started to embrace: Value-based care, which determines how much health care costs based on how effective it is, rather than how much a service costs.
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The phenomenon is often joked about (in a rather sardonic manner): A trip to the emergency room or the doctor’s office ends with a steep bill mailed to the patient. One patient detailed a more than $700 cost to push morphine through an IV, a process that takes seconds.
Through value-based care, the argument goes, providers may be incentivized to spend more time with each patient and offer higher quality care. This could be a game changer for everyone involved. Physicians often get paid more by having more patients, which leads to short, hyperefficient appointments with each patient and leads to burnout. What if they could get paid better while seeing fewer people and spending more time with each of them?
“Primary care physicians are an integral part of the U.S. healthcare system, and all share a mission to see their senior patients live healthy, independent lives free from the burden of chronic disease,” Dr. Sanjay Doddamani, co-founder and CEO of Upstream, said in a statement. “However, they often lack the resources and technology to achieve their goals while also struggling to thrive financially in the value-based care era.”
More staffing and support
Upstream provides doctors working with Medicare patients with a team of nurses and pharmacists to shoulder some of the workflow often left to physicians. Using its technology platform of electronic health records and clinical data, the team can forecast potential health risks for each patient and get ahead of it.
Providing preventive care, such as lowering the risk of a patient getting diabetes, is far less costly to the health care system than managing a patient that already has diabetes. And for the U.S., which spends far more on health care than other countries with very little return, preventive care will be key to lowering the exorbitant cost of keeping people alive.
Illustration: Dom Guzman
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